Surgical site infections after cesarean section in Gaza: Incidence, risk factors, and microbial profile

Background Surgical site infections (SSIs) are significant complications following Cesarean sections (CSs), particularly in resource-limited settings. This study analyzed the incidence, risk factors, and microbial profile of post-CS SSIs. Methods A descriptive prospective cohort study (August 2022–August 2023) at a maternity hospital in Gaza, monitored women undergoing CS using standardized surveillance. SSIs were defined per CDC criteria. Given the anatomical nature of CS, infections requiring hospital management were primarily classified as deep incisional or organ/space SSIs. Wound swabs from suspected cases underwent standard microbiological culture and identification. Data were analyzed using SPSS version 21. Results Among 5428 Cesarean sections, the overall SSI rate was 2% (111 cases). All recorded cases were deep incisional ( n = 95, 85.6%) or organ/space ( n = 16, 14.4%) infections. The mean age was 29 ± 6.9 years. Urgent procedures accounted for 85% of cases. Preexisting conditions were present in 58% of cases; common risk factors included previous surgery (38%), premature rupture of membranes (23%), and hypertension (22%). Microbiological analysis ( n = 94 positive cultures) revealed that Gram-negative bacteria accounted for 48.9% (46/94) of isolates ( E. coli 20.2%, Klebsiella spp. 19.1%), while Gram-positive bacteria represented 51.1% (48/94) ( S. epidermidis 33.0%, S. aureus 14.9%). Conclusion The SSI rate was 2%. Urgent procedures and comorbidities are major risk factors. The microbial profile highlights both enteric and skin organisms, though interpretation is limited by absent susceptibility testing. Enhanced infection prevention protocols, preoperative care, and sustained surveillance are essential for reducing incidence.